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A tool accompanying the Systematic Assessment ofRehabilitation Situation (STARS)

TEMPLATE F R REHABILITATION INFORMATION

COLLECTION

TRIC

IN HEALTH SYSTEMSGUIDE FOR ACTION

World Health Organization20 Avenue Appia 1211-Geneva 27Switzerland

https://www.who.int/rehabilitation/en/

ISBN 978-92-4-151600-6



ISBN 978-92-4-151601-3



COLLECTION

TRIC


Template for Rehabilitation Information Collection (TRIC): a tool accompanying the Systematic Assessment of Rehabilitation Situation (STARS)

ISBN 978-92-4-151601-3

© World Health Organization 2019

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iii

Contents

Acknowledgements iv

Acronyms v

BACKGROUND 1

USING THE TEMPLATE FOR REHABILITATION INFORMATION COLLECTION (TRIC) 3

TEMPLATE FOR REHABILITATION INFORMATION COLLECTION 5

SECTION 1: GENERAL COUNTRY INFORMATION 51.1 POPULATION PROFILE 61.2 SOCIOCULTURAL PROFILE 61.3 REHABILITATION NEEDS 7

SECTION 2: TEMPLATE FOR REHABILITATION INFORMATION COLLECTION 92.1 LEADERSHIP AND GOVERNANCE 92.2 FINANCING FOR REHABILITATION 112.3 HUMAN RESOURCES FOR REHABILITATION 122.4 REHABILITATION SERVICE DELIVERY 182.5 ASSISTIVE TECHNOLOGY 232.6 REHABILITATION INFRASTRUCTURE 262.7 REHABILITATION INFORMATION 272.8 EMERGENCY PREPAREDNESS 28

SECTION 3: SOURCES OF INFORMATION 303.1 STAKEHOLDERS INTERVIEWED 303.2 LITERATURE AND ONLINE SOURCES 31

ANNEX 1: GUIDANCE FOR COMPLETING THE TEMPLATE FOR REHABILITATION INFORMATION COLLECTION 32

ANNEX 2: REHABILITATION MAPPING 40

iv TEMPLATE FOR REHABILITATION INFORMATION COLLECTION (TRIC)

Acknowledgements

The World Health Organization (WHO) extends its gratitude to all whose dedicated efforts and expertise contributed to this resource.

The development and field testing of this resource was coordinated by Pauline Kleinitz, Rehabilitation Programme, WHO, with the support of Alarcos Cieza, Coordinator for Vision, Hearing, Rehabilitation, Disability, Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, WHO.

This resource was designed in consultation with WHO personnel at headquarters, regional and country level. During its development and field testing it benefited from the input of Darryl Barrett, Eduardo Celades, Shelly Chadha, Vivath Chou, Antony Duttine, Michelle Funk, ZeeA Han, Chapal Khasnabis, Ivo Kocur, Lindsay Lee, Maryam Mallick, Elanie Marks, Christopher Mikton, Jody-Anne Mills, Satish Mishra, Alexandra Rauch, Carla Sabariego, Hala Sakr, and Emma Tebbutt.

The resource was field tested with the support of WHO regional and country offices, rehabilitation consultants and the governments of Botswana, Guyana, Haiti, Jordan, Lao People’s Democratic Republic, Myanmar, Solomon Islands, and Sri Lanka. Special thanks are extended WHO country office colleagues, including Hadeel Alfar, Subhashini Caldera, Paul Edwards, Kirsten Fransden, Moagi Gaborone, Donie Mallawaarachi, and Aye Moe Moe. Additional thanks go to representatives from governments who provided feedback, including Shiromi Maduwage, Ariane Mangar, Khin Myo Hla, Gaboelwe Rammekwa and Elsie Talofiri, and to consultants who provided feedback, including Charlotte Axelsson, Jerome Canicave, Sue Eitel and Monika Mann.

A number of rehabilitation experts provided input to the conceptualization and development of the resource, including, Jerome Bickenbach, Max Deneu, Zeon De Wet, Bernard Franck, Christoph Gutenbrunner, Jorge Lains, Kirsten Lentz, Graziella Lippolis, Gwynnyth Llewellyn, James Middleton, Susanne Nielsen, Gerald Stucki, Isabelle Urseau, and Marc Zlot.

The development and publication of this Rehabilitation Guide for Action was made possible through support from the United States Agency for International Development (USAID).

vAcronyms

Acronyms

ACTOR Action on Rehabilitation

AP Assistive Products

FRAME Framework for Rehabilitation Monitoring and Evaluation

GRASP Guidance for Rehabilitation Strategic Planning

ICD International Classification of Diseases

NCD Noncommunicable disease

NGO Nongovernmental organization

RIM Rehabilitation Indicator Menu

SHA System of National Health Accounts

SDGs Sustainable Development Goals

STARS Systematic Assessment of Rehabilitation Situation

TRIC Template for Rehabilitation Information Collection

UHC Universal Health Coverage

WHO World Health Organization

1 TEMPLATE FOR REHABILITATION INFORMATION COLLECTION (TRIC)

BACKGROUND

The World Health Organization’s Template for Rehabilitation Information Collection (TRIC) is part of the Systematic Assessment of Rehabilitation Situation (STARS) guidance. STARS guides users through Phase 1 of a four-phase process that supports governments in strengthening rehabilitation in their health systems, see Table 1. Findings from a STARS situation assessment should inform development of a rehabilitation strategic plan.

Phase 1 includes four steps, and completion of the TRIC by government occurs during step 2, see Figure 1. The TRIC directs the collation of data across the six-health system building blocks: leadership and governance, financing, human resources, health services, medicines and technology, health information systems, and includes a section on emergency preparedness and infrastructure. The information collected in the TRIC supports steps 3 and 4 of STARS.

ASSESS THE SITUATION

DEVELOP A REHABILITATION

STRATEGIC PLAN

ESTABLISH MONITORING, EVALUATION, AND REVIEW

PROCESSES1 2 3

SYSTEMATIC ASSESSMENT OF REHABILITATION SITUATION

STARS

GUIDANCE FOR REHABILITATION AND STRATEGIC PLANNING

GRASP

FRAMEWORK FOR REHABILITATION MONITORING AND EVALUATION

FRAME

ACTION ON REHABILITATION

ACTOR

IMPLEMENT THE STRATEGIC PLAN4

Table 1. The Four-Phase Process and Accompanying Guidance

2Background

Figure 1: Overview of phases, steps and accompanying guidance and tools in the WHO rehabilitation in health systems: guide for action

Four-phase process

Phas

e 1.

STA

RSRM

M

TRIC

Phase 2. GRASP

Prepare for situation assessment

Collect data and information

Conduct assessment in the country

Write, revise and finalize report, disseminate and communicate findings

5 Prepare for strategic planning

7Consult, revise, finalize and

complete costing of plan 6Identify priorities

and produce first draft of plan

8Endorse and

disseminate the strategic plan

9Develop monitoring

framework with indicators, baselines

and targets

10Establish evaluation

and review processes

11Establish a recurring implementation

“plan, do, evaluate” cycle

12 Increase capacity of rehabilitation leadership and governance

12 MONTHS

Phase 4. ACTOR

Phas

e 3.

FRA

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RIM

1

2

3

4

Phase 1. STARSASSESS THE SITUATION

• Follow the four steps of the Systematic Assessment of Rehabilitation Situation (STARS) to undertake a comprehensive situation assessment

• Use the Template for Rehabilitation Information Collection (TRIC) within STARS to direct collection of data and information

• Use the Rehabilitation Maturity Model (RMM) within STARS to structure the assessment and its findings

• Produce a high-quality situation assessment report

Phase 2. GRASPDEVELOP A REHABILITATION STRATEGIC PLAN

• Follow the four steps of the Guidance for Rehabilitation Strategic Planning (GRASP) to undertake a strategic planning process

• Produce a high-quality strategic plan

Phase 3. FRAMEESTABLISH MONITORING, EVALUATION, AND REVIEW PROCESSES

• Follow the two steps of the Framework for Rehabilitation Monitoring and Evaluation (FRAME) to establish a monitoring framework for the strategic plan and an evaluation and review process

• Use the Rehabilitation Indicator Menu (RIM) to guide selection of indicators, then identify baselines and targets

Phase 4. ACTORIMPLEMENT THE STRATEGIC PLAN

• Follow the two steps of the Action on Rehabilitation (ACTOR) guidance to establish the recurring implementation cycle

• Build capacity of rehabilitation governance and leadership to improve implementation of the rehabilitation strategic plan over time

3 TEMPLATE FOR REHABILITATION INFORMATION COLLECTION (TRIC)

USING THE TEMPLATE FOR REHABILITATION INFORMATION COLLECTION (TRIC)

Before completing the TRIC, it is essential that users read the STARS guidance in WHO’s Rehabilitation in health systems: guide for action.

Who completes the TRIC and when?Only one version of this template should be completed by government, typically by the focal person for rehabilitation within the Ministry of Health. This person may draw on government and other non-governmental stakeholders to collect the information. They must compile all the data and then return one version to WHO and the consultant (if one is being used) prior to the in-country assessment period. The TRIC should be given to the government approximately 8 weeks before the in-country assessment period of STARS to allow enough time for data collation.

This tool has been designed for low- and middle-income countries and for use at either national or subnational level. If the assessment is being done at subnational level, substitute “national” or “country” in TRIC with “subnational”, “state”, or “province”, as appropriate.

Is there a brief version of the TRIC available?In each section of the template, certain questions are shaded in darker blue. Collectively these questions constitute a rapid assessment. A rapid assessment can be conducted when the information necessary to complete the full tool is not available or when time and human resources are lacking. A rapid assessment, based on this subset of questions, only provides a basic overview of the rehabilitation and it is strongly recommended that users complete the full assessment.

Where can information to complete the TRIC be found?Information to complete the TRIC can be drawn from various sources. Completing the TRIC will require desk-based data collection and, when necessary, stakeholder interviews.

Desk-based data collection

The following desk-based sources should provide much of the information necessary to complete the TRIC:

• Peer-reviewed literature

• WHO/UN statistics

• Data from the National Statistics Office

• Administrative data from the Ministry of Health and/or Ministry of Social Affairs

Stakeholder interviews

Interviews with the following stakeholders may provide additional information to complete the TRIC:

• Government rehabilitation focal points

• Ministry of Health and Ministry for Social Affairs (or national equivalents)

• Rehabilitation professional associations

• Representatives of rehabilitation training institutes or programmes

• Nongovernmental and international organizations engaged in rehabilitation service delivery, training or development

• Health facility staff, such as hospital or hospital department managers

Further detail on sources of information to complete TRIC can be found in Annex 1 of this document.

4USING THE TEMPLATE FOR REHABILITATION INFORMATION COLLECTION (TRIC)

How long does it take to complete the TRIC?The length of time it takes to complete the TRIC depends on how readily available rehabilitation information is in the country and how well the government prioritizes the task. Where rehabilitation is regularly collected and compiled, the TRIC may take several hours. However, where this is not the case and information needs to be obtained from multiple sources, the TRIC may take several days spread over a period of 3–4 weeks. Sources should be recorded and attached to the information to assist with analysis. If additional space is required when responding to questions, then use the ‘Comments/Additional Information’ box or create a Word document and include information with the corresponding question number.

What is contained in the different sections of the TRIC?Section one: “General country information” includes questions about demographics and data on rehabilitation needs.

Section two: The TRIC includes questions relating to the situation of rehabilitation in the following areas:

• Leadership and governance

• Financing for rehabilitation

• Human resources for rehabilitation

• Rehabilitation service delivery

• Assistive technology

• Rehabilitation infrastructure and medications

• Rehabilitation information and research

• Emergency preparedness

It is recommended that this section be completed with Annex 1 at hand so that possible sources of information and relevant definitions can be readily referred to.

Section three: “Sources of information” is a template to record the sources from which information was drawn. Recording the sources of information can help to verify details, speed up future assessments, and strengthen mechanisms for routine data collection.

Annex 1. “Guidance for completing the TRIC tool” provides more detailed information on completing the different sections of the questionnaire, including possible sources of information and definitions.

Annex 2. “Rehabilitation service map” provides a template to record what rehabilitation services exist and where they are located. This is particularly useful when there are only a limited number of services in the country or area being assessed.

TEMPLATE FOR REHABILITATION INFORMATION COLLECTION (TRIC)5

TEMPLATE FOR REHABILITATION INFORMATION COLLECTION

SECTION 1: GENERAL COUNTRY INFORMATION

Name of the country and area in which this assessment is being conducted

Country State/region/province

Name of person responsible for this assessment

First (and middle) name Family name

Designation and qualification

Address

Street and number

City Postcode

Country

Telephone number E-mail

Development partner(s) involved (include name and contact details)


1.1 POPULATION PROFILE

1.1.1 Total population

1.1.2 Age distribution of population (%)

Adjust age brackets as required

0–5 years: 6–15 years:

16–60 years: > 60 years:

1.1.3 Sex distribution (%) Male: Female:

1.1.4 Rural-urban distribution (%) Rural: Urban:

Slum1 population (if applicable):

1.1.5 Life expectancy at birth

1.1.6 Disability prevalence (%)

Include source, multiple if available

%:

Source:

1.1.7 Any other population-related factors that need to be considered in planning services

Include details of indigenous, ethnic minorities and displaced population(s) if applicable

1.2 SOCIOCULTURAL PROFILE

1.2.1 Languages

1.2.2 Religions

Add approximate % population for each

1.2.3 Literacy rate (as a % of total population)

1.2.4 Other significant sociocultural factors, such as the country’s experience of war or natural disasters

1 The United Nations defines a slum by five characteristics: inadequate access to safe water; inadequate access to sanitation and infrastructure; poor structural quality of housing; overcrowding; and insecure residential status (see the Housing and slum upgrading section of UN Habitat’s website at http://unhabitat.org/urban-themes/housing-slum-upgrading/, accessed 11 June 2016).

http://unhabitat.org/urban-themes/housing-slum-upgrading/


1.3 REHABILITATION NEEDSThis section seeks only quality information that can inform rehabilitation needs in the population. Use only quality data from population surveys or administration data such as registries. Include any information relevant to the country, and the source of the information should be recorded in Section 3.2.

1.3.1 Trauma (number of cases a year or rates per 10 000)

Road traffic injuries:

Significant burns:2

Falls:

Injuries:

Additional trauma relevant to country or area being assessed and for which robust data are available:

1.3.2 Prevalence of noncommunicable disease (% of population)

Cancer:

Diabetes:

Cardiovascular disease:

Respiratory disease:

Other:

1.3.3 Number of cases of stroke per year

1.3.4 Prevalence of significant communicable disease (% of population)

For example prevalence of HIV/AIDS, neglected tropical diseases:

1.3.5 Prevalence of disabling vision loss3 (% of population)

1.3.6 Prevalence of disabling hearing loss3 (% of population)

1.3.7 Prevalence of age-related health conditions

For example frailty, dementia:

1.3.8 Prevalence of developmental and neurological conditions in children (% of population if available)

For example intellectual impairment, developmental delay, autism, cerebral palsy, spina bifida, epilepsy:

1.3.9 Prevalence of neurological conditions in adults (% of population if available)

For example multiple sclerosis, spinal cord injury, traumatic brain injury

2 Include definition of “significant burn” based on degree and total body surface area (TBSA) used to establish the figure provided.3 If information not available, indicate definition used in estimation of prevalence.


1.3.10 Prevalence of mental health conditions (% of population if available)

Depression:

Anxiety:

Schizophrenia:

Bipolar disorder:

Other significant mental health conditions relevant to the country or area being assessed:

1.3.11 Prevalence of congenital anomalies (% of population if available)

Cleft lip:

Club foot:

Other congenital anomalies significant to country or area being assessed:

1.3.12 Musculoskeletal conditions Prevalence of osteoarthritis and rheumatoid arthritis (% of population):

Incidence of hip fractures (cases per year):

Prevalence of lower limb amputations (total number or % of population):

Any other significant musculoskeletal conditions for which there is reliable data (such as low back pain):

1.3.13 Other information related to need and demand for rehabilitation


SECTION 2: TEMPLATE FOR REHABILITATION INFORMATION COLLECTION

2.1 LEADERSHIP AND GOVERNANCE

2.1.1 Which ministry is responsible for rehabilitation in the country?

If multiple, list all

2.1.2 Is rehabilitation included in health policy and legislation frameworks?

If yes, describe how and where it is included

Yes No

Details:

2.1.3 Is rehabilitation included in the national health strategic plan?

If yes, describe how and where it is included

Yes No

Details:

2.1.4 Has rehabilitation been included within health service planning processes?

If yes, describe how this has occurred – for example, within which other areas of health?

Yes No

Details:

2.1.5 Is there a designated unit and/or officer for rehabilitation within the ministry structure?

If yes, provide details, including number of equivalent full-time staff allocated to rehabilitation

Yes No

Details:

2.1.6 Is there a dedicated national rehabilitation policy or legislative framework?

If yes, attach it

Yes No

Details:

2.1.7 Is there a dedicated strategic plan specifically for rehabilitation?

If yes, provide title, timeframe and attach them

Yes No

Details:

2.1.8 Is there a clear governance structure for rehabilitation?

Describe this, including if it has a committee, steering group, technical working group etc.

Yes No

Details:


2.1.9 Are there any mechanisms for coordination of rehabilitation between ministries?

If yes, provide details

Yes No

Details:

2.1.10 Are there any national reporting processes and/or monitoring frameworks for rehabilitation?

If yes, provide details of this, including frequency of reporting

Yes No

Details:

2.1.11 Is information and evidence regarding rehabilitation service availability and uptake used to inform service planning?

If yes, describe what evidence is used

Yes No

Details:

2.1.12 Do regulatory frameworks for health exist and apply to rehabilitation?

If yes, describe which ones apply to rehabilitation. For example, health professional accreditation, health facility accreditation, medical product standards

Yes No

Details:

2.1.13 Are rehabilitation users included in the governance and/or decision-making process for rehabilitation?

If yes, describe how they are included

Yes No

Details:

2.1.14 Is there an early childhood development (ECD) policy, and does it include early childhood intervention?

Are there inter-sectoral leadership and coordination mechanisms that include early childhood intervention (ECI)?

ECD Policy Yes No

ECD Policy inclusive of ECI Yes No

Yes No

Details:

Comments and additional information


2.2 FINANCING FOR REHABILITATION

2.2.1 Is there an allocated budget for rehabilitation?

If yes, from which ministry or ministries?

Yes No

Ministry/ministries:

2.2.2 What is the annual public expenditure for rehabilitation?

If from multiple ministries, then include amount from each

Ministry and amount:

2.2.3 Is there an allocated budget for assistive products?

If yes, from which ministry/ministries

Yes No

Ministry/ministries:

2.2.4 What is the annual public expenditure for assistive products?

If from multiple ministries, then include amount from each.

Specify if assistive product expenditure is included in the rehabilitation expenditure (question 2.2.2) and disaggregate if possible.

Ministry and amount:

Are assistive products included in rehabilitation expenditure?

Yes No

Details of amounts:

2.2.5 What is the annual total health expenditure?

Amount:

2.2.6 What are the major health financing mechanisms? Name these mechanisms and describe if and how rehabilitation is included

Details:

2.2.7 For insurance-based health financing mechanism, describe the levels of coverage in the population and criteria for enrolment. Do any population groups or diagnoses get excluded?

Details:

2.2.8 Which type of rehabilitation is covered by which major health financing mechanisms?

Details:


2.2.9 Are there any financing mechanisms that include rehabilitation targeting children with developmental delays and disabilities? These may be linked to early childhood intervention services and special education services

Details:

2.2.10 Does the government contract agencies, such as nongovernmental organizations (NGOs) to deliver rehabilitation services – either within, or separate from, major health financing mechanisms?

If yes, provide details on number of organizations contracted, amount spent and services they deliver

Yes No

Organizations contracted:

Services delivered:

Annual amount spent:

2.2.11 What is the percent of out-of-pocket (OOP) health costs in the country? Is there specific information in relation to rehabilitation? If so, describe. What are the typical OOP costs for rehabilitation in a government facility? Provide an example for a hip fracture

OOP as % of total health expenditure:

Specific information about rehabilitation OOP costs:

Typical OOP rehabilitation costs in government facility :

2.3 HUMAN RESOURCES FOR REHABILITATION

2.3.1 Considering all government and private health services, which, if any, of the following rehabilitation professionals are available at the primary healthcare level?

Physiotherapists4

Occupational therapists

Speech and language therapists5

Audiologists

Prosthetists and orthotists

Physical and rehabilitation doctors

Psychologists

Other rehabilitation professional cadre(s):

4 Physiotherapists are synonymous with physical therapists in the context of this tool.5 Speech and language are synonymous with speech and language pathologists in the context of this tool.


2.3.2 Considering all government and private health services, which, if any, of the following rehabilitation professionals work in secondary hospitals?

Physiotherapists


Speech and language therapists

Audiologists



Psychologists


2.3.3 Considering all government and private health services, which, if any, of the following rehabilitation professionals work in tertiary hospitals?

Physiotherapists



Audiologists



Psychologists


2.3.4 Considering all levels of health services in the country (often more than primary, secondary and tertiary), list each level and mark if rehabilitation professionals are available. The lines provided are for a six-level health care system – adjust as appropriate.

Level name rehabilitation professional






2.3.5 For each level of health service in your country, list the total number of facilities, and the number of facilities with rehabilitation professionals. Repeat for each level.

*If feasible, provide further detailed information on a separate sheet about the number of rehabilitation professions and professionals available in each of the facilities. For example: Level 2 hospital; 25 hospitals; 25 with rehabilitation professionals; 12 with 3+ rehabilitation professions, total 180 professionals.

Level name Total number of facilities at this level

Number of facilities with a rehabilitation professional


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a

Bac

helo

r

Mas

ter

Doc

tora

te

Oth

er:

Nat

iona

l:

Inte

rnat

iona

l:

Yes

No

Yes

No

DPr

osth

etic

s an

d or

thot

ics8

pers

onne

l (c

ateg

ory

I)

Publ

ic se

ctor

:

Priv

ate

sect

or:

NGO

s:

Tota

l:

U

rban

%:

Rura

l %:

Prim

ary

%:

Seco

ndar

y %

:

Tert

iary

%:

Dip

lom

a

Bac

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r

Mas

ter

Doc

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te

Oth

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Dip

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Nat

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Inte

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Yes

No

Yes

No

6 It is understood that in many countries rehabilitation professionals will be working in both public and private sector simultaneously – dual practice. Where this occurs, it is suggested to only count the professionals who are working full-time in the private sector.7 “International” refers to someone who has come from another country, been trained there, and is now supplementing the workforce in the country being assessed. 8 Refer to the guidelines for training personnel in developing countries for prosthetic and orthotic services at http://apps.who.int/iris/bitstream/10665/43127/1/9241592672.pdf.

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2.3.5 2.3.6 2.3.7 2.3.8 2.3.9 2.3.10 2.3.11 2.3.12 2.3.13 2.3.14

Total numbers Number per 10 000

Distribution

Educational requirement for entry into the workforce

Which of the following are offered in the country?

Number of education institutions offering courses

Number of national graduates each year

Is there professional accreditation?

Is there a professional association?

% qualified personnel that emigrate annually?

A Physiotherapists Public sector:

Private sector:6

NGOs:

Total:

Urban %:

Rural %:

Primary %:

Secondary %:

Tertiary %:

Diploma

Bachelor

Master

Doctorate

Other:

Diploma

Bachelor

Master

Doctorate

Other:

National:

International:7

Yes

No

Yes

No

B Occupational therapists

Public sector:

Private sector:

NGOs:

Total:

Urban %:

Rural %:

Primary %:

Secondary %:

Tertiary %:

Diploma

Bachelor

Master

Doctorate

Other:

Diploma

Bachelor

Master

Doctorate

Other:

National:

International:

Yes

No

Yes

No

C Speech and language therapists

Public sector:

Private sector:

NGOs:

Total:

Urban %:

Rural %:

Primary %:

Secondary %:

Tertiary %:

Diploma

Bachelor

Master

Doctorate

Other:

Diploma

Bachelor

Master

Doctorate

Other:

National:

International:

Yes

No

Yes

No

D Prosthetics and orthotics8 personnel (category I)

Public sector:

Private sector:

NGOs:

Total:

Urban %:

Rural %:

Primary %:

Secondary %:

Tertiary %:

Diploma

Bachelor

Master

Doctorate

Other:

Diploma

Bachelor

Master

Doctorate

Other:

National:

International:

Yes

No

Yes

No

2.3.5 2.3.6 2.3.7 2.3.8 2.3.9 2.3.10 2.3.11 2.3.12 2.3.13 2.3.14


Distribution








E Prosthetics and orthotics personnel (category II)

Public sector:

Private sector:

NGOs:

Total:

Urban %:

Rural %:

Primary %:

Secondary %:

Tertiary %:

Diploma

Other:

Diploma

Other:

National:

International:

Yes

No

Yes

No

F Physical and rehabilitation medicine doctors

Public sector:

Private sector:

NGOs:

Total:

Urban %:

Rural %:

Primary %:

Secondary %:

Tertiary %:

N/A National:

International:

Yes

No

Yes

No

G Rehabilitation nurses

Public sector:

Private sector:

NGOs:

Total:

Urban %:

Rural %:

Primary %:

Secondary %:

Tertiary %:

Diploma

Bachelor

Master

Doctorate

Other:

Diploma

Bachelor

Master

Doctorate

Other:

National:

International:

Yes

No

Yes

No

H Psychologists Public sector:

Private sector:

NGOs:

Total:

Urban %:

Rural %:

Primary %:

Secondary %:

Tertiary %:

Diploma

Bachelor

Master

Doctorate

Other:

Diploma

Bachelor

Master

Doctorate

Other:

National:

International:

Yes

No

Yes

No

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9 Other rehabilitation cadres may include other medical doctors playing a significant role in rehabilitation, such as developmental paediatricians. This section also includes community-based rehabilitation (CBR) workers. See note regarding CBR workers in Annex 1 if this is to be included.

2.3.5 2.3.6 2.3.7 2.3.8 2.3.9 2.3.10 2.3.11 2.3.12 2.3.13 2.3.14


Distribution








Ι Other rehabilitation cadre(s) (if more than one, include details separately for each)9

Name Number Distribution Educational requirement for entry into the workforce

Which agency provides the training?

Number qualified each year

Describe the services this rehabilitation professional cadre provides

Urban %:

Rural %:

Primary %:

Secondary %:

Tertiary %:

Diploma

Other:

Government

Nongovernmental or international organization

Private educational institute

Rehabilitation workforce initiatives

2.3.15 Is the national rehabilitation workforce augmented by international professionals (i.e. those from other countries)?

If yes, select the professions to which this applies:

Yes No

Physiotherapists



Audiologists



Social workers

Psychologists

Other:

2.3.16 What is the average annual salary (on graduation) of a rehabilitation therapist (physiotherapist, occupational therapist, speech and language therapist)?

2.3.17 Are any salary or in-kind incentives offered to rehabilitation professionals (e.g. scarce skill allowance, car or housing support)? If yes, please describe.

Yes No

Describe:

2.3.18 What is the average annual salary (on graduation) of a medical doctor and a nurse? Medical doctor: Nurse:

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2.3.19 Which, if any, of the following mechanisms are currently being implemented to scale up rehabilitation workforce?

Government-led planning (provide details):

Increasing the number of posts available

Government scholarships for rehabilitation personnel

International recruitment

Mandated work setting post-graduation (e.g. rural)

Incentives to retain skilled rehabilitation professionals (specify):

Other, explain:

2.3.20 What support and supervision mechanisms are in place for rehabilitation personnel? Describe:

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2.4 REHABILITATION SERVICE DELIVERY

Rehabilitation is assessed under the following headings:

Availability of common types of rehabilitation:10

Quality: Effective, timely, person-centred and safe

Specialized, high-intensity rehabilitation

2.4.1 Are there specialized, high-intensity and longer stay rehabilitation centres/wards/units/hospitals for people with complex rehabilitation needs?

If yes, provide details of their bed capacity, the patient groups they cater for (such as people with spinal cord injury or traumatic brain injury) if applicable, and which agency operates the centre

If insufficient space, complete on a separate sheet

Yes No

Name:

Rehabilitation bed capacity:

Rehabilitation outpatient/day programme capacity:

Patient group(s):

Operated by:

Government

Nongovernmental and international organizations

Private providers

Name:



Patient group(s):

Operated by:

Government


Private providers

Name:



Patient group(s):

Operated by:

Government


Private providers

2.4.2 What is the total number of dedicated rehabilitation beds in the country (if any)?

Total rehabilitation beds :

10 The structure of this section aligns to the Rehabilitation in Health Framework that forms part of the STARS guidance in the WHO Rehabilitation in health systems: guide for action. Refer to the guide to view this framework. See Annex 1 of this document for descriptions of these different types of rehabilitation.

1. Specialized, high intensity rehabilitation 2. Rehabilitation integrated into tertiary health care3. Rehabilitation integrated into secondary health care 4. Rehabilitation integrated into primary health care 5. Rehabilitation delivered in the community

6. Rehabilitation that is informal and self-directed occurring in community settings

7. Rehabilitation across all phases of acute, subacute and long-term care

8. Rehabilitation for children 9. Rehabilitation for the target population groups


Rehabilitation integrated into tertiary and secondary health care

2.4.3 Is rehabilitation integrated into tertiary and secondary health care in both hospital and clinic settings?

Rehabilitation in tertiary health care:

Yes No

In some hospitals, but not others (describe what is available and where)

Rehabilitation in secondary health care:

Yes No

In some hospitals, but not others (describe what is available and where)

2.4.4 Are inpatient and/or outpatient rehabilitation services available in tertiary and secondary level hospitals?

Inpatient

Outpatient

Both

Varies depending on the hospital

Rehabilitation integrated primary health care

2.4.5 Is rehabilitation integrated into primary health care?

Does the country have a defined package of services for provision of primary health care?

If yes, are rehabilitation services/interventions integrated in the package?

If yes, outline them

Yes No

Details:

Package of services for provision of primary health care

Yes No

Rehabilitation services/interventions integrated in the package

Yes No

Outline the rehabilitation services:

Community-delivered rehabilitation

2.4.6 Are there rehabilitation services being delivered in the community?

Describe the range of community-delivered rehabilitation services, e.g. community outreach, mobile clinics, community-based rehabilitation, condition specific. Include which agency provides these services (government ministry, NGO, private)?

If no, proceed to 2.4.8

Yes No

Details:


2.4.7 Are community-delivered rehabilitation services available across all districts in the country? Describe coverage, include the total number of districts and number that are covered

Yes No

Details of coverage:

Total number of districts:

Number of districts covered:

Informal and self-directed rehabilitation. For example, by carers in the home or a long-term care setting

2.4.8 Is informal and self-directed care widely occurring in community settings? Examples of this may be carers supporting rehabilitation in long-term care settings; childcare or education workers carrying out rehabilitation with clients and peer support groups.

Yes No

Details of its occurrence:

Rehabilitation services across all phases of care: acute, subacute and long-term care

2.4.9 Is rehabilitation available in acute care – e.g. within intensive care units, emergency departments and acute medical wards?

Yes No

Details:

2.4.10 Is rehabilitation available in subacute care – e.g. within general hospitals, outpatients, and rehabilitation centres?

Yes No

Details:

2.4.11 Is rehabilitation available in long-term care, e.g. within long-term care facilities, day centres, and community centres?

Yes No

Details:

Rehabilitation for children

2.4.12 Is there hospital-based paediatric rehabilitation for children with developmental delays and disabilities? Describe these, e.g. multi-disciplinary developmental assessment clinics, children’s hospital programmes.

Yes No

Details:


2.4.13 Is there paediatric rehabilitation for children with disabilities or developmental delays delivered in the community?

If yes, describe and state who delivers these and any information on extent of coverage

Yes No

Details:

2.4.14 Are mechanisms in place within health services that support early identification and referral for children with developmental delays and disabilities?

If yes, describe these

Yes No

Details:

2.4.15 Is rehabilitation provided in schools, or for school-aged children?

If yes, describe who delivers these and include information on extent of coverage

Yes No

Details of programmes delivered and the coverage:

2.4.16 Are there programmes available for children with specific developmental delays and disabilities?

If yes, list them

For example, autism spectrum disorder, intellectual disability, club foot

Yes No

Details:

2.4.17 Is there an early childhood intervention network, association, or programme operating in the country?

Yes No

Details:

Rehabilitation for target population groups

2.4.18 Are data on rehabilitation needs in specific target population group available? For example, for victims of unexploded ordinance? If yes, name groups

Yes No

Details:

2.4.19 Are there any rehabilitation programmes designed to meet the specific needs of a target population? (For example, programmes for landmine victims).

If yes, please list them.

(Below are questions for older people, people with mental health conditions, and people with vision and hearing impairments)

Yes No

List the rehabilitation programmes that have been developed for target populations:


2.4.20 Is there rehabilitation that targets older people, e.g. fall prevention programmes, programmes addressing frailty?

Yes No

Details:

2.4.21 Is there rehabilitation for people with vision or hearing loss? Examples include Low Vision Clinics, Orientation and Mobility Training and Hearing Aid Provision.

If yes, describe it.

Yes No

Details:

2.4.22 Is there rehabilitation for people with mental health conditions? If yes, describe it.

Yes No

Details:

Rehabilitation quality

2.4.23 Are there national clinical practice guidelines, models of care, standards and protocols that support delivery of effective evidence-based rehabilitation services? If yes, indicate which exist and rate their availability

National clinical practice guidelines

Very few Some Many

Models of care

Very few Some Many

Standards

Very few Some Many

Protocols

Very few Some Many

2.4.24 Are there effective referral processes, care pathways, case management and case coordination practices that support timely delivery of rehabilitation along a continuum of care? If yes, rate the extent to which these practices occur and list the common practices.

None Very few Some Many

Details/list:

2.4.25 Within rehabilitation, are the practices of goal setting, multidisciplinary teamwork and measurement of functioning outcomes utilized? To what extent are they utilized?

Not commonly utilized

Sometimes utilized

Frequently utilized

Consistently utilized

Details/list:


2.4.26 Is the practice of person-centred care commonly used in rehabilitation? This includes frequent education and empowerment of users and their family/carers, user input to service decision making, delivering flexible, tailored services

Rate the extent to which person-centred care is utilized and list the common practices

Not commonly utilized

Sometimes utilized

Frequently utilized

Consistently utilized

Details/list:

2.4.27 Is there a system by which rehabilitation is regularly monitored for quality, e.g. quality assurance programmes, facility level accreditation programmes, service audits and regular service user feedback analysis?

Yes No

Details:


2.5 ASSISTIVE TECHNOLOGY

2.5.1 Does the country have a strategy, plan or roadmap that incudes assistive products (AP)?

Yes No

Details:

2.5.2 Does the country have an essential list of APs? If yes, provide information and attach the list.

Refer to WHO 50 priority assistive products (APL11) if needed.

Yes No

Details:

2.5.3 Is there a financial mechanism /scheme that covers or subsidizes the cost of AP – e.g. a national health insurance, or national AP programme?

If yes, name the financial mechanism/scheme and who is entitled to benefit. Please attach a list of products (or groups of products) covered by the scheme

Yes No

Name of scheme:

Beneficiaries:

Percentage of population covered by scheme:

Details of scheme, including if assessment, fitting, training etc is included:

11 Refer to Annex 1 for the WHO Priority Assistive Product List, or go to http://apps.who.int/iris/bitstream/10665/207694/1/WHO_EMP_PHI_2016.01_eng.pdf?ua=1, accessed 12 June 2019.

http://apps.who.int/iris/bitstream/10665/207694/1/WHO_EMP_PHI_2016.01_eng.pdf?ua=1


2.5.4 Are there taxes and duties on imported assistive products and or their component parts? If so please specify the tax and or duties on each product?

Yes No

Details:

2.5.5 What regulatory mechanism are relevant to AP? Any quality or safety standards before AP can be placed on the market?

If yes, provide details:

Yes No

Details:

2.5.6 Do written guidelines or service standards exist for the provision of AP?

If yes, provide details of who sets for what products?

Yes No

Details:

2.5.7 Who are the main stakeholders who procure AP in the country? List the top 3.

Select all that apply

Main Stakeholders:

Bulk purchase. From whom:

Yearly tendering. From whom:

Individual need. From whom:

Other (specify):

2.5.8 Are there technical specifications available to guide procurement of assistive products? If so, for which assistive products?

Yes No

Details:

2.5.9 Who is the key workforce that provide assistive products? Please specify the key personnel who provide AP across the 6 domains of AP.

Mobility products:

Hearing products:

Vision products:

Communication products:

Self-care products:

Cognition products:


2.5.10 Which types of AP are available within the country?

Are any of these AP produced locally?

MOBILITY

Manual wheelchairs, assistant controlled Manual wheelchairs, for active users Electric/powered wheelchairs Walking frames and Rollators Canes/sticks (including tripods, quadripods) Crutches, axilliary/elbow Therapeutic footwear; diabetic, neuropathic, orthopaedic Chairs for bath/shower/toilet Orthoses Prostheses Club foot braces Ramps, portable Pressure-relief12 cushions

VISION

Spectacles Magnifiers, optical Magnifiers, digital, hand-held Braille equipment White canes Watches, talking/touching Audio players with DAISY capability13

HEARING / COMMUNICATION

Hearing aids (digital) and batteries Alarm signallers with light/sound/vibration Communication boards/books/cards

SELF CARE / COGNITIVE

Incontinence products, absorbent Charis for bath/shower/toilet Pill organizers Personal emergency alarm systems Simplified mobile phones

Products produced and /or assembled locally, if any:

2.5.11 Are there quality regulations or safety standards for AP that need to be met before they are made available to users?

If yes, outline standards or regulations on a separate sheet, or provide a link

Yes No

Details:

12 In this context, pressure-relieving products include those made from air or high-profile foam that are specifically designed for pressure relief. 13 DAISY (Digital Accessible Information System) is software that enables text to be converted to audio and is typically used by people with a visual and/or cognitive impairment that

limits their ability to read.


2.5.12 Are there service standards for the provision of AP?

If yes, who sets these standards?

Yes No

Who sets the standards?


2.6 REHABILITATION INFRASTRUCTURE

2.6.1 Which of these statements is most accurate when describing the availability of rehabilitation equipment and consumables in the country or area being assessed?

Rehabilitation providers in both community and hospital settings have access to all the equipment and consumables they require to provide quality rehabilitation

Rehabilitation providers in both community and hospital settings have access to some of the rehabilitation equipment and consumables they require to provide quality rehabilitation

Rehabilitation providers in hospital settings have access to some of the equipment and consumables they require to provide quality rehabilitation but access to those in community settings is inadequate

Access to rehabilitation equipment and consumables is generally inadequate in both community and hospital settings

Other (describe the situation regarding rehabilitation equipment and consumable availability):

2.6.2 Which, if any, of the following commonly used rehabilitation-related medications is available in government services in the country?

Botulinum toxin A – for muscle spasticity Baclofen Corticosteroids Non-steroidal anti-inflammatory drugs (NSAIDS)

2.6.3 Do secondary and tertiary hospitals have designated purpose-built space/gyms available for rehabilitation assessment and interventions?

Yes No

Therapy gymnasium(s)

Number of hospitals (if known)?

Describe common equipment in gym:

Kitchen and bathroom for activity of daily living assessment and intervention

Number of hospitals (if known)?

Separate treatment rooms and cubicles for different professional services



2.7 REHABILITATION INFORMATION

Health information system

2.7.1 Within the health information system, are data collected regarding the functioning of the population, e.g. through comprehensive disability surveys or the WHO Model Disability Survey?

If yes, provide details

Yes No

Details:

2.7.2 Within the health information system (such as the district health management information systems – DHMIS), are data routinely collected regarding the availability and utilization of rehabilitation services?

If yes, describe what data are collected

Yes No

Details:

2.7.3 Do agencies, other than the government rehabilitation facilities (e.g. NGOs), collect rehabilitation related data?

List the agencies and what data they collect

Agency and data collected:

2.7.4 Do data collected in rehabilitation facilities reach the Ministry of Health rehabilitation unit/focal officer?

Explain how the data are transmitted, what the data cover, and how much is sent

Yes No

Details:

2.7.5 Within the health information system, are data collected that apply the coding of the International Classification of Functioning, Disability and Health (ICF)?

Yes No

Details:

2.7.6 Are any high-level indicators related to rehabilitation reported on by the government?

If yes, list these

Yes No

List of indicators:


Research

2.7.8 Are any agencies or institutes conducting research in the field of rehabilitation?

If yes, provide the names of the agencies or institutes

If no, proceed to section 2.8

Yes No

Names:

2.7.9 What is the main focus of the research in the field of rehabilitation?

Clinical rehabilitation research

Rehabilitation system-level research

Research related to the cost-effectiveness of rehabilitation

Other (please specify):

2.7.10 Which are the key funding bodies supporting research in the field of rehabilitation?

Is rehabilitation a priority area of research for any of these funding bodies?

Details:

Yes No


2.8 EMERGENCY PREPAREDNESS

If the country or area being assessed is not at risk of experiencing emergencies, skip this section

2.8.1 Is rehabilitation integrated in emergency response plans?

Yes No

Details:


2.8.2 Is there a plan for managing a potential surge of rehabilitation needs in the event of a sudden onset disaster?

If yes, attach plan to report

Yes No

Details:

2.8.3 Is the rehabilitation capacity mapped and known to the Ministry of Health and Health Emergency Operation Centre/National Emergency Management Agency?

Yes No

Details:

2.8.4 Is there rehabilitation available in areas at high risk of sudden onset disaster?

If yes, outline the type(s) of rehabilitation services

Yes No

Number and types of services:

2.8.5 Is there a stockpile of AP in high-risk areas?

If yes, select which AP are stored and add quantities if possible

If there are multiple stockpiles in different areas, detail these on a separate sheet

Yes No In some high-risk areas, but not others

Assistive products:

Wheelchairs

Crutches

Walking frames

Prefabricated orthoses

Other (specify):

2.8.6 Are there established referral pathways between rehabilitation services in high risk areas and those in low risk areas?

If yes, attach details to report

Yes No

Details:



SECTION 3: SOURCES OF INFORMATION

3.1 STAKEHOLDERS INTERVIEWED

Name and job title/role

(If listed in stakeholder analysis, simply record number, e.g. 3.1.4)

Contact details

3.1.1 Telephone:

Email:

3.1.2 Telephone:

Email:

3.1.3 Telephone:

Email:

3.1.4 Telephone:

Email:

3.1.5 Telephone:

Email:

3.1.6 Telephone:

Email:

3.1.7 Telephone:

Email:

3.1.8 Telephone:

Email:

3.1.9 Telephone:

Email:

3.1.10 Telephone:

Email:

3.1.11 Telephone:

Email:

3.1.12 Telephone:

Email:

3.1.13 Telephone:

Email:

3.1.14 Telephone:

Email:

3.1.15 Telephone:

Email:

3.1.16 Telephone:

Email:


3.1.17 Telephone:

Email:

3.1.18 Telephone:

Email:

3.1.19 Telephone:

Email:

3.1.20 Telephone:

Email:

3.2 LITERATURE AND ONLINE SOURCES (Peer-reviewed articles, books, online resources, or other written sources of information)

3.2.1

3.2.2

3.2.3

3.2.4

3.2.5

3.2.6

3.2.7

3.2.8

3.2.9

3.2.10

3.2.11

3.2.12

3.2.13

3.2.14

3.2.15

3.2.16

3.2.17

3.2.18

3.2.19

3.2.20


ANNEX 1: GUIDANCE FOR COMPLETING THE TEMPLATE FOR REHABILITATION INFORMATION COLLECTION

GLOSSARY – GENERAL

Rehabilitation intervention. A health intervention is an act performed for, with or on behalf of a person or population whose purpose is to assess, improve, maintain, promote or modify health, functioning or health conditions. A rehabilitation intervention is a form of health intervention that is designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment. Health conditions refers to disease (acute or chronic), disorder, injury or trauma. A health condition may also include other circumstances such as pregnancy, ageing, stress, congenital anomaly, or genetic predisposition. Rehabilitation may be needed by anyone with a health condition who experiences some form of limitation in functioning, such as in mobility, vision or cognition.

Rehabilitation. Rehabilitation is a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment. Rehabilitation occurs in specialised rehabilitation services and when the delivery of rehabilitation interventions is integrated into a wide range of other health services.

Rehabilitation – health strategy. Rehabilitation is characterized by interventions that address impairments, activity limitations and participation restrictions, as well as personal and environmental factors (including assistive technology) that have an impact on functioning. WHO considers rehabilitation to be a health strategy alongside health promotion, prevention, curative and palliative care. Rehabilitation is a highly person-centred health strategy; treatment caters to the underlying health condition(s) as well as goals and preferences of the user.

Rehabilitation user. A rehabilitation user(s) is a person(s) who are recipients of rehabilitation interventions. They are also sometimes referred to as clients, patients and consumers.

Rehabilitation personnel. Rehabilitation personnel include both rehabilitation professionals and informally trained health workers who support or conduct the work of rehabilitation professionals in their absence or because of a limited number.

Rehabilitation professionals. Rehabilitation professionals cover a range of professions, including physiotherapy, occupational therapy, orthotics and prosthetics, rehabilitation nursing, physical rehabilitation medicine (physiatry), psychology, and speech and language therapy, and more. The scope of practice, qualifications and registration of each profession varies by country. See definitions of key professions below.

Other health personnel. This phrase is used in the context of the Rehabilitation in health systems: guide for action to describe all the other health personnel that are not specifically rehabilitation personnel, these personnel may also be trained to deliver rehabilitation interventions.

1.1 Population, socio-political profile and rehabilitation needs

SOURCES

Possible sources of information on the country or area’s population profile include:

• Most recent national census data

• United Nations Department of Economic and Social Affairs: www.un.org/development/desa/en/

• The World Bank: www.worldbank.org

• Global Health Observatory: www.who.int/gho/countries/en/

• WHO State of inequality report: www.who.int/gho/health_equity/report_2015/en/

• International Telecommunications Union: www.itu.int/en/ITU-D/Statistics/Pages/stat/default.aspx

• Institute for International Health Metrics and Evaluation: www.healthdata.org/gbd

https://www.un.org/development/desa/en/

http://www.worldbank.org

http://www.who.int/gho/countries/en/

http://www.who.int/gho/health_equity/report_2015/en/

http://www.itu.int/en/ITU-D/Statistics/Pages/stat/default.aspx

http://www.healthdata.org/gbd


2.1 Leadership and governance

SOURCES

Information about how rehabilitation is positioned and represented in the government and about rehabilitation policy can be obtained through review of government documents and stakeholder interviews with relevant personnel in the Ministry of Health and/or the Ministry for Social Affairs (or national equivalents). Information may also be found on government websites and public health publications.

2.1.2–2.1.7

DEFINITIONS

A rehabilitation policy, plan or strategic plan refers to a document that details the country’s priorities, goals and direction regarding rehabilitation.

2.2 Financing for rehabilitation

SOURCES

See 2.1 above.

2.3 Human resources for rehabilitation

SOURCES

Information on the rehabilitation workforce may be available through administrative sources in the ministry of health, national professional councils, other government departments including the department for education, and professional associations:

• World Confederation of Physical Therapy (WCPT): http://www.wcpt.org/

• World Federation of Occupational Therapy (WFOT): http://www.wfot.org/

• International Association of Logopedics and Phoniatrics (IALP) (speech therapists): http://www.ialp.info/

• International Society of Audiology (ISA): http://www.isa-audiology.org/

• International Society for Prosthetics and Orthotics (ISPO): http://www.ispoint.org/

• International Society for Physical and Rehabilitation Medicine (ISPRM): http://www.isprm.org/

• International Council of Psychologists (ICP): http://www.icpweb.org/

Information on professional accreditation may be sought from professional associations or regulators.

http://www.wcpt.org/

http://www.wfot.org/

http://www.ialp.info/

http://www.isa-audiology.org/

http://www.ispoint.org/

http://www.isprm.org/

http://www.icpweb.org/


2.3.1, 2.3.2 and 2.3.5

DEFINITIONS

These definitions are provided as a guide, so countries should use their own national classifications of the different levels of health care.

Primary health care. This refers to services delivered by health professionals who act as a first point of consultation.14 Where needed they provide a link to more specialized care. Primary care is usually based at the local level and provided in a range of settings.

Secondary health care. This is health care provided by medical specialists and other health professionals, it is not the first entry point to the health services. Secondary care is usually based at the district/regional level and provided in a range of hospital and clinic settings. The hospital settings are often those with five to 10 clinical specialties; size ranges from 200 to 800 beds; often referred to as a provincial, general or regional hospital.15

Tertiary health care. This is considered more specialized and consultative health care. Tertiary care is usually based at the national level and provided in hospital settings. The hospital settings are those that provide highly specialized care and may have teaching facilities. They typically range from 300–1500 beds and are often referred to as national, central or teaching hospitals.

See definitions of the various rehabilitation-related professions below.

Physiotherapists are people professionally trained through a formal diploma or degree in physiotherapy (or physical therapy). Physiotherapists provide services that develop, maintain and restore maximum movement and functional ability throughout the lifespan.16

Occupational therapists are people professionally trained through a formal diploma or degree in occupational therapy. Occupational therapists provide services that help people participate in everyday activities.17

Speech and language therapists are people professionally trained through a formal diploma or degree in speech and language therapy. Speech and language therapists provide services that assess and treat people with speech and language disorders, and with swallowing disorders.18

Prosthetics and orthotics personnel are those who assess, prescribe and fit prostheses and orthotics. Orthotics and prosthetics personnel are categorized into three levels according to their education and scope of practice:

Category I (prosthetists and orthotists) are people professionally trained through a formal degree (4-year university degree or equivalent);

Category II (either orthopaedic technologist, lower limb prosthetics or orthotics technologist,or upper limb prosthetics/orthotics and spinal orthotics technologist) have different degree requirements (3-year formal structured education for orthopaedic technologists and 1-year formal structured education plus relevant clinical experience for the remaining category II groups; and

Category lll (prosthetic/orthotic technician, or equivalent term), have usual requirements for technician training in that country, often basic education with 2 years or less formal training as well as on-the-job training.

Physical and rehabilitation doctors are people with a medical degree that have undergone additional education or training in physical and rehabilitation medicine. Physical and rehabilitation doctors provide assessment and medical interventions focused on function.19

14 Ear and hearing care situation analysis tool, 2016. Geneva; World Health Organization; 2016.15 Henser M, Price M, Adomakoh S. Referral hospitals. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB et al., editors. Disease Control Priorities in Developing

Countries. Washington DC: Oxford University Press and The World Bank: 2006.16 Description of physical therapy [policy statement]. London: World Confederation of Physical Therapy. (http://www.wcpt.org/policy/ps-descriptionPT, accessed 12 June 2019). 17 About Occupational Therapy [website]: World Federation of Occupational Therapists. https://www.wfot.org/about-occupational-therapy, accessed 12 June 2019)18 Speech, language, and swallowing [website]. Rockville, MD: American Speech-Language-Hearing Association (http://www.asha.org/public/speech/, accessed 12 June 2019).19 What is a physiatrist? [website]. Rosemont, Il: American Academy of Physical Medicine and Rehabilitation (http://www.aapmr.org/about-physiatry/about-physical-medicine-

rehabilitation/what-is-physiatry, accessed 12 June 2019).

http://www.wcpt.org/policy/ps-descriptionPT

https://www.wfot.org/about-occupational-therapy

http://www.asha.org/public/speech/

http://www.aapmr.org/about-physiatry/about-physical-medicine-rehabilitation/what-is-physiatry

http://www.aapmr.org/about-physiatry/about-physical-medicine-rehabilitation/what-is-physiatry


Rehabilitation nurses are registered/professional nurses who have undergone additional education and training in rehabilitation nursing. They work to diagnose and treat individuals and groups who have experienced actual health problems resulting from altered functional ability and altered lifestyle, as well as preventative care for potential health problems.20

Psychologists are people professionally trained through a formal diploma or degree in psychology. Psychologists are concerned with people’s mental (including cognitive) health and provide psychological assessment and support.

Other rehabilitation cadres. Most commonly this include community-based rehabilitation (CBR) workers or therapy assistants. When reporting CBR workers for TRIC, only record if their scope of practice includes individual rehabilitation interventions – i.e. the rehabilitation and assistive technology elements of the CBR matrix.21 Do not record CBR workers in this assessment if their role is largely focused on disability mainstreaming or disability-inclusive development, i.e. the education, livelihood, social and empowerment components of the CBR matrix.

2.4 Rehabilitation delivery

2.4.1 – 2.4.21

SOURCES

Information regarding service delivery models, infrastructure and service providers is best sought from administrative data and experts within the Ministry of Health and/or Ministry of Social Affairs. In addition, information regarding rehabilitation service delivery in the community, in hospitals and for specific user groups should be sought from relevant service/hospital managers, coordinators or other well-informed rehabilitation service providers.

DEFINITIONS

The Rehabilitation in Health Framework informs the STARS guidance by providing a common structure and organization of rehabilitation. Across countries there is significant variation in the c The Rehabilitation in Health Framework informs the STARS guidance by providing a common structure and organization of rehabilitation. Across countries there is significant variation in the configuration of rehabilitation. This framework highlights common types of rehabilitation and suggests an optimal mix of rehabilitation in a country. It utilizes an adapted version of the commonly applied pyramidal structure of primary to tertiary health care. The following definitions accompany Figure 5 in the STARS guidance.

Specialized, high-intensity rehabilitation

Characteristics: This type of rehabilitation is specialized with capacity for high-intensity delivery in a longer-stay facility or programme. This rehabilitation is commonly for people with complex needs that impact on multiple domains of functioning. This rehabilitation is considered tertiary care and may start in the acute phase and continue into the sub-acute phase. Services may be highly specialized for one health condition, such as in a spinal cord injury, or provide rehabilitation for people with a range of health conditions in a dedicated rehabilitation centre. In this type of rehabilitation, the rehabilitation interventions are delivered by rehabilitation personnel but can also be delivered by other specialized health personnel.

Key user groups: People with spinal cord injury, traumatic brain injury, burns, stroke, major trauma, orthopaedic fracture and replacements, deconditioning, pain, organ transplant, amputation and a range of other cardiovascular, neurological and psychiatric conditions.

Settings: Longer-stay rehabilitation hospitals, centres, units and departments, through in-patient, out-patient and day programmes. It may also include specialized psychiatric hospitals or units where rehabilitation is intensely delivered, such as a burn or stroke unit.

20 Scope of rehabilitation nursing practice [website]. Chicago, Il: United States of America Association of Rehabilitation Nurses http://www.rehabnurse.org/about/content/Scope-of-Practice.html, accessed 12 June 2019).

21 About the community-based rehabilitation (CBR) matrix. Geneva: World Health Organization (http://www.who.int/disabilities/cbr/matrix/en/, accessed 12 June 2019).

http://www.rehabnurse.org/about/content/Scope-of-Practice.html

http://www.rehabnurse.org/about/content/Scope-of-Practice.html

http://www.who.int/disabilities/cbr/matrix/en/


Rehabilitation integrated into medical specialties in tertiary and secondary health care

Characteristics: This type of rehabilitation is less specialized and typically delivered for a short period during the acute- or sub-acute phases of care. It is integrated into health services and programmes for people with a wide range of conditions who are being treated in tertiary and secondary health care. In this type of rehabilitation, the rehabilitation interventions are most commonly delivered by rehabilitation personnel but can also be delivered by other health personnel.

Key user groups: People with a wide range of musculoskeletal, neurological, cardiovascular, respiratory, geriatric, psychiatric, internal organ, hearing, vision, gynaecological, paediatric and other health conditions.

Settings: Tertiary or secondary hospital and clinic settings. Hospitals may be general with multiple medical specialties or they may be specialized, such as an eye, ear or cancer hospitals.

Rehabilitation integrated into primary health care

Characteristics: This type of rehabilitation is delivered within the context of primary health care, which includes the services and professionals that act as a first point of contact into the health system. It may be delivered during the acute-, sub-acute and long-term phases of care. In this type of rehabilitation, the rehabilitation interventions are most commonly delivered by rehabilitation personnel but can also be delivered by other primary health care personnel.

Key user groups: People with musculoskeletal, neurological, cardiovascular, paediatric and or psychiatric conditions.

Settings: Primary health care centres, clinics, single- or multi-professional practices and community settings.

Community-delivered rehabilitation

Characteristics: This type of rehabilitation is distinguished through its delivery in community settings. Community settings include a home, school, workplace, community centres, and may also include a health centre, clinic or post. Tertiary, secondary and primary care can all be delivered in a community setting, most commonly this type of rehabilitation is a form of secondary care and occurs during the sub-acute and long-term phases of care. It is delivered with moderate- to low-intensity over a short, intermittent (episodic) or long-term period. This type of rehabilitation is delivered through a range of mechanisms, examples include; outreach by rehabilitation personnel into a home, school or workplace; and regular mobile clinics where rehabilitation personnel deliver interventions such as assistive products. This type of rehabilitation may also be integrated into other health and social programmes, such as; in-home nursing care; early childhood intervention programmes; and disability focused community services. In this type of rehabilitation, the rehabilitation interventions are most commonly delivered by rehabilitation personnel but can also be delivered by other health personnel.

Key user groups: Delivery of rehabilitation in community settings is rationalized for people whom delivery in these settings further optimizes their functioning and who have difficulties accessing rehabilitation outside of these settings. User groups include people recently discharged from a specialized, high intensity service; people with intermittent (episodic) rehabilitation needs and limited access to transportation; children with developmental difficulties and disabilities; older people accessing specialized health programmes; people with vision conditions or degenerative disease; people with psychiatric conditions, and people receiving rehabilitation in long-term care facilities such as a nursing home.

Settings: Homes, schools, childcare centres, workplaces, leisure centres, long-term care facilities, hospices, community centres and health centres and clinics.


Informal and self-directed care

Characteristics: This type of rehabilitation is not a rehabilitation service but part of informal and self-directed care, occurring where there may be no rehabilitation or health personnel present. It occurs during a rehabilitation episode or as part of an individual rehabilitation plan, it may also occur when people initiate their own rehabilitation to maintain or further improve their functioning, commonly over a long-term period. Examples of this include carers supporting rehabilitation in long-term care settings, education workers carrying out rehabilitation with children with disability in schools, people with lower back pain undertaking yoga or tai chi classes, peer support group activities, and coaches incorporating rehabilitation into sports training programmes. It also includes the rehabilitation exercises performed by people in their homes to maintain or improve their functioning.

Key user groups: This includes anyone who initiates activities to maintain or further improve their functioning.

Settings: Homes, schools, parks, workplaces, health club or resorts, swimming pools, community centres, long-term care facilities.

Rehabilitation across all phases of acute, subacute and long-term care is defined as rehabilitation care delivered for any health condition during these phases which are defined as follows:

Acute: short-term treatment for an acute health condition. This is primarily delivered in hospital settings that should include medical and surgical wards, intensive care units and emergency departments.

Subacute (and post-acute): inpatient or outpatient care following an acute health condition or exacerbation of a health condition. It is of moderate duration and this care may be designed to improve the transition from hospital to the community. This is primarily delivered through tertiary and secondary hospitals, rehabilitation wards, units, programmes, and could also be in public or private single or multi-professional practices.

Long term: care that is provided over a long period to meet both the medical and non-medical needs of people with a chronic health condition or disability. This primarily occurs in rehabilitation centres and programmes (often ambulatory programmes), programmes for long-term degenerative conditions, and in respite or institutional settings such as nursing homes.

Rehabilitation for children is focused on services for children with developmental difficulties and disabilities. But, as is the case with other items in this tool, the assessment is not exhaustive and other areas of paediatric rehabilitation exist but are not included. Services for children with development difficulties and disabilities are commonly divided into early childhood intervention services (0–7years) and school-age services. These include hospital and community-based services as well as the early identification mechanisms.

Rehabilitation for target population groups refers to rehabilitation that has been developed for a group of people in the population that have significant rehabilitation needs and benefit from targeted/specifically designed programmes and services. Common examples of programmes are for amputees (e.g. from landmines), burns or degenerative conditions such as Parkinson’s. In the context of this tool, there are also specific questions for people in need of rehabilitation for vision and hearing impairments, mental health conditions, as well as older people. Regarding mental health conditions, in the context of this tool, rehabilitation services for people with mental health conditions do not include provision of medication or electroconvulsive therapy.


2.5 Assistive technology

SOURCES

Information regarding the availability and financing of assistive products may be sought from administrative data and the government ministry or ministries responsible for assistive products. Depending on the context, this may include the ministries of health, social affairs (or equivalent), education, and the military.

Further information may also be sourced from major manufacturers and organizations involved in the distribution and provision of assistive products.

2.5.1–2.5.9

DEFINITIONS

Assistive technology. This is the application of organized knowledge and skills related to assistive products, including systems and services. Assistive technology is a subset of health technology.

Assistive products. Any external product (including devices, equipment, instruments or software), especially produced or generally available, the primary purpose of which is to maintain or improve an individual’s functioning and independence, and thereby promote their well-being. Assistive products are also used to prevent impairments and secondary health conditions22.

Priority assistive products. Those products that are highly needed, an absolute necessity to maintain or improve an individual’s functioning and which need to be available at a price the community/state can afford.

2.5.3 World Health Organization’s 50 Priority assistive products list (APL) 1. Alarm signallers with light/sound/vibration

2. Audio players with DAISY capability

3. Braille displays (note takers)

4. Braille writing equipment/braillers

5. Canes/sticks

6. Chairs for shower/ bath/toilet

7. Closed captioning displays

8. Club foot braces

9. Communication boards/books/cards

10. Communication software

11. Crutches, axillary/ elbow

12. Deafblind communicators

13. Fall detectors

14. Gesture to voice technology

15. Global positioning system (GPS) locators

16. Handrails/grab bars

17. Hearing aids (digital) and batteries

18. Hearing loops/FM systems

19. Incontinence products, absorbent

20. Keyboard and mouse emulation software

21. Magnifiers, digital hand-held

22. Magnifiers, optical

23. Orthoses, lower limb

24. Orthoses, spinal

25. Orthoses, upper limb

26. Personal digital assistant (PDA)

27. Personal emergency alarm systems

28. Pill organizers

29. Pressure relief cushions

30. Pressure relief mattresses

31. Prostheses, lower limb

32. Ramps, portable

33. Recorders

34. Rollators

35. Screen readers

36. Simplified mobile phones

37. Spectacles; low vision, short distance, long distance, filters and protection

38. Standing frames, adjustable

39. Therapeutic footwear; diabetic, neuropathic, orthopaedic

40. Time-management products

41. Travel aids, portable

42. Tricycles

43. Video communication devices

44. Walking frames/ walkers

45. Watches, talking/ touching

46. Wheelchairs, manual for active use

47. Wheelchairs, manual assistant-controlled

48. Wheelchairs, manual with postural support

49. Wheelchairs, electrically powered

50. White canes

22 Priority assistive product list. Improving access to assistive technology for everyone, everywhere. Geneva: WHO Press; 2016.


2.6 Rehabilitation infrastructure and medications

SOURCES

Information regarding rehabilitation infrastructure and medications is best sought from experts within the Ministry of Health and/or Ministry of Social Affairs. Information may also be sourced from relevant service/hospital managers, coordinators or other well-informed rehabilitation service providers.

2.6.1 DEFINITIONS

Basic rehabilitation equipment and infrastructure includes but is not limited to:

• Plinths

• Rigid transfer boards

• Plaster of Paris bandages

• Plaster cutters

• Plaster spreaders

• Upper limb slings

• Stump compression bandages

• Tubular compression bandages

• Compression bandages

• Spirometers

• Stump boards

• Sliding boards for wheelchair transfers

• Leg raisers for wheelchairs

• Stethoscopes

• Blood pressure monitors

• Percussion/reflex hammers

• Goniometers

• Tape measures

• Splinting equipment23

• Abdominal binders

2.7 Rehabilitation information and research

SOURCES

Information about health information systems may be sourced from administrative data from the Ministry of Health, statistical offices (national or subnational), or from researchers in the field.

Research information may be obtained from research institutions and prominent researchers in the field.

2.7.6

DEFINITIONS

The International Classification of Functioning, Disability and Health (ICF) is a classification of health and health-related domains. It includes a coding system for reporting information related to body functions, body structures, activities and participation, and environmental factors.24

2.8 Emergency preparedness

SOURCES

Information about rehabilitation services in areas at high risk of emergency and about preparedness initiatives may be sought from administrative data and rehabilitation focal points within government (when possible), or from subnational rehabilitation managers/directors. More detailed information regarding the stockpiling of assistive products may need to be sourced from the rehabilitation services themselves.

2.8.1

DEFINITIONS

In the context of this assessment, a sudden onset disaster is a geophysical event – such as an earthquake, tsunami, landslide, or volcanic activity or other event – that can result in high numbers of deaths and injuries,and overwhelm local health services.

23 Splinting equipment includes, but is not limited to, thermoplastic sheets, heat gun, portable water heater (hydrocollator or large pan), velcro (adhesive hook and non-adhesive loop), splinting scissors, neoprene glue and padding.

24 International Classification of Functioning, Disability and Health. Geneva: WHO Press; 2008.

ANNEX 2: REHABILITATION MAPPING

Where feasible (in countries where rehabilitation is limited), it may be useful to record what rehabilitation is available and where, and provide a brief description. This information can be complimented by a map that shows the distribution of rehabilitation in the country or area, and road access to it.

Service name Provider Brief description– Type of rehabilitation provided– Who uses the service?

Address Contact person Contact details (email and phone)

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ISBN 978-92-4-151601-3

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